Stomach Ulcer

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a stomach ulcer?

Stomach ulcer, also known as gastric ulcer or peptic ulcer, is a localized area of erosion in the stomach lining. Symptoms include abdominal pain, possible bleeding, and other gastrointestinal symptoms. The most common cause of a stomach ulcer is infection associated with Helicobacter pylori (H. pylori) bacteria. Another term for a stomach ulcer is peptic ulcer disease, which is when ulcers form in the stomach or first part of the small intestine (duodenum).

The spread of H. pylori between people is not completely understood; it may spread through contaminated food and water. Many people become infected with H. pylori at a young age, but symptoms most commonly occur in adulthood. In some people, the H. pylori bacteria cause an infection in the lining of the stomach or duodenum, which may lead to an ulcer. Damage to the stomach lining from stomach acid increases the likelihood that H. pylori infection will cause a stomach ulcer.

Other risk factors for stomach ulcers include alcohol use, tobacco use, and prolonged use of medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs). Severe illness has also been associated with developing a stomach ulcer.

The signs and symptoms of a stomach ulcer can be constant or sporadic, and the disease course varies among individuals. If H. pylori is the cause, the symptoms will remain as long as the infection is untreated. Some people with stomach ulcers have no symptoms at all, while others may have burning pain, severe nausea, and vomiting.

In the case of H. pylori-related stomach ulcers, the infection can be treated successfully with antibiotics. For stomach ulcer not related to H. pylori, antacids or other medications are an effective treatment. You can reduce your risk of H. pylori infection by following commonsense hygiene practices, such as washing your hands with soap and water prior to preparing food and after handling dirty diapers or using the bathroom.

Seek immediate medical care (call 911) for serious symptoms of a stomach ulcer, such as severe abdominal pain, bloody or black tarry stools, or bloody or black vomit.

Seek prompt medical care if you are being treated for stomach ulcer, but mild symptoms recur or are persistent.

What are the symptoms of a stomach ulcer?

Stomach ulcers cause inflammation and damage to the stomach lining. These sores in the lining of the stomach result in several symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of a stomach ulcer

You may experience stomach ulcer symptoms daily or just once in a while. For many people, the symptoms worsen after eating a meal. At times, any of these common symptoms can be severe:

  • Abdominal bloating
  • Abdominal burning
  • Abdominal pain
  • Feeling of fullness
  • Nausea with or without vomiting

Serious symptoms that might indicate a life-threatening condition

In some cases, a stomach ulcer can be life-threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Severe abdominal pain

What causes a stomach ulcer?

A stomach infection associated with Helicobacter pylori (H. pylori) bacteria is the most common cause of stomach ulcers. The bacteria affect stomach acid and act on the stomach’s lining, making it more vulnerable to acid and digestive fluids. With time, breaks occur in the lining, which can keep eroding and create a sore.

Alcohol, tobacco, and medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can also lead to stomach ulcers. Severe illness and radiation therapy have also been associated with stomach ulcers.

Many people around the world have H. pylori, but not everyone gets peptic ulcer disease like stomach ulcers. This means other factors are involved, including environmental and genetic factors.

What are the risk factors for a stomach ulcer?

A number of factors increase the risk of developing a stomach ulcer. Not all people with risk factors will get an ulcer.

Risk factors for stomach ulcers include:

  • Alcohol abuse
  • Family history of stomach or duodenal ulcers 
  • Regularly taking NSAIDs, such as ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin
  • Stress or severe illness
  • Tobacco use

Reducing your risk of developing a stomach ulcer

You may be able to lower your risk of developing a stomach ulcer by:

  • Not drinking alcohol or limiting alcohol intake less than two drinks per day for a man and one drink per day for a woman
  • Not using or minimizing nonsteroidal anti-inflammatory medications like ibuprofen (Advil, Motrin)
  • Not using tobacco products

What are the diet and nutrition tips for stomach ulcers?

Many studies have shown that neither food nor stress is the source of peptic ulcers. In general, focus on a healthy diet with plenty of fiber, and avoid any foods or drinks, including alcohol and spicy products, that cause digestive problems or worsen stomach ulcer symptoms. A high-fiber diet may help prevent new ulcers from forming. If you are not used to a high-fiber diet, start slowly with small portions.

A healthy diet naturally contains many sources of fiber, including:

  • Fruits and vegetables, particularly apples, pears, sweet potatoes, and Brussels sprouts
  • Legumes like lentils, peas and black beans
  • Seeds and nuts (including nut butters)
  • Whole grains like barley, oat bran and oatmeal

Dietary restrictions include items that tend to increase stomach acid production, such as:

  • Alcohol, at least until the ulcer heals
  • Caffeinated beverages, or limit to less than three cups of coffee (or equivalent) a day

Ask your healthcare provider for guidance before making significant changes to your diet.

How do doctors diagnose a stomach ulcer?

Healthcare professionals diagnose stomach ulcers based on the patient’s symptoms, physical exam, and medical history, including a discussion about current medication use. Tell your healthcare provider about all over-the-counter and prescription drugs you take, as well as vitamins and herbal supplements. Laboratory tests and, in some cases, imaging tests may be necessary to confirm the diagnosis or determine its cause.

Diagnostic and imaging tests for stomach ulcers include:

  • H. pylori test, which requires a breath, blood or stool test 

      

  • Barium swallow, which is an X-ray of your upper digestive tract after you drink a chalky liquid. The barium in the liquid makes it easier to see abnormalities like ulcers on X-rays.  
  • Upper endoscopy, which involves inserting a camera scope into your mouth and down your throat to examine the stomach lining. (You are under sedation for the test.) The doctor, usually a gastroenterologist, looks at the lining for signs of an ulcer or other abnormalities. He or she may perform a biopsy for a detailed analysis of the tissue. If there is active bleeding from the ulcer, the doctor may be able to treat the area with medicine during the endoscopy.

What are the treatments for a stomach ulcer?

Treatment for a stomach ulcer depends, in part, on the cause. If nonsteroidal anti-inflammatory drugs (NSAIDs) are the probable cause, stopping use will help the ulcer heal. If you normally take NSAIDs for a chronic condition, ask your doctor about alternate anti-inflammatory drugs.

If the cause is Helicobacter pylori bacterial infection, antibiotic therapy is the mainstay of treatment. It is important to follow the antibiotic regimen precisely to avoid reinfection or recurrence. Most commonly, two antibiotics are prescribed for 14 days.

Antibiotic treatments to treat H. pylori infection include:

  • Clarithromycin (Biaxin)
  • Metronidazole (Flagyl)
  • Tetracycline

Other medications for treating a stomach ulcer

The standard stomach ulcer treatment is “triple therapy,” consisting of the two antibiotics and one acid reducer. Medications that decrease the amount of acid in the stomach, such as proton pump inhibitors and histamine H2-receptor antagonists, may be prescribed for 4 to 8 weeks or longer.

Proton pump inhibitors that are effective in the treatment of gastric ulcer include:

  • Lansoprazole (Prevacid)
  • Pantoprazole (Protonix)
  • Rabeprazole (Aciphex)

Histamine H2-receptor antagonists that are effective in the treatment of gastric ulcers include:

  • Cimetidine (Tagamet)
  • Famotidine (Pepcid)
  • Nizatidine (Axid)
  • Ranitidine (Zantac)

There are also prescription drugs to protect the stomach lining as the ulcer heals.

If you have diarrhea and vomiting, fluid and electrolyte replenishment is also a component of successful treatment.

Surgery may only be necessary for complications of a stomach ulcer, such as major bleeding or when there is a hole in the stomach.

At-home care and lifestyle tips for stomach ulcers

To improve healing time:

  • Do not smoke: Smoking affects how the digestive system neutralizes stomach acid and inhibits healing.
  • Limit or do not drink alcohol. This drug irritates the lining of the digestive tract.
  • Relax. Even though emotional stress does not cause ulcers, stress can interfere with recovery. Practice stress reduction techniques, such as exercise, meditation, and get togethers with friends.
  • Take acetaminophen for pain and fever. It is safer to take acetaminophen (such as Tylenol) than ibuprofen and other NSAIDs for pain relief and fever when you have a stomach ulcer or if you develop frequent ulcers. NSAIDs are very effective, but they increase the risk of bleeding. 

Alternative treatments for stomach ulcers

There is some evidence for a beneficial effect of these agents on ulcers:

  • Bismuth, a metal and main ingredient in Pepto-Bismol
  • Fish oil or fish oil supplements, which may inhibit the growth of H. pylori
  • Licorice, deglycyrrhizinated (DGL), which may work in place of bismuth as a stomach lining protectant. It may also inhibit H. pylori bacterial growth, based on studies of GutGard. DGL is also a common alternative remedy for indigestion
  • Mastic gum, based on its antimicrobial properties, particularly against H. pylori
  • Probiotics to help replenish your gut with good bacteria during antibiotic treatment

How long does it take a stomach ulcer to heal?

With medication, it may take several weeks for the ulcer to heal. Eating a healthy diet, limiting or omitting alcohol, and not smoking will encourage healing.

Can a stomach ulcer heal on its own?

Stomach ulcers may heal on their own, without medication, and by reducing risk factors for stomach ulcers. However, if you have H. pylori and do not treat it, it is unlikely the ulcer will heal. Ulcers can also reoccur after successful treatment.

How does a stomach ulcer affect quality of life?

Stomach ulcers are a form of peptic ulcer disease, which includes ulcers in the stomach or first part of the small intestine (duodenum). Duodenal ulcers are more common than stomach (gastric) ulcers. Some people with peptic ulcer disease recover but develop recurrent ulcers. It is considered a chronic disease.

Peptic ulcers decrease quality of life physically, psychologically and behaviorally, all of which can negatively interfere with how the individual manages the disease. Both the disease and its treatment have negative consequences. It can lead to decreased productivity, increased expenses, and changes in social interactions.

Understanding more about quality of life in relation to the disease and treatment side effects can help both patients and providers develop an effective treatment plan, which will increase the likelihood of recovery.

Coping tips for stomach ulcer

These strategies may improve health-related quality of life and help prevent complications of disease:

  • Follow your treatment plan.
  • Focus on a healthy lifestyle, which includes exercising regularly, consuming healthy meals, not smoking, limiting alcohol, and getting enough sleep and sunshine.
  • Maintain social engagements.
  • Share your concerns about disease symptoms or treatment side effects with the prescribing doctor.

What are the potential complications of a stomach ulcer?

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of gastric ulcer include:

  • Internal hemorrhaging (bleeding), the most common complication. Bleeding usually stops spontaneously, but about 25% of cases require surgery, according to Johns Hopkins Medicine. 
  • Perforated gastric ulcer, which is when there is a hole in the stomach
  • Severe discomfort or pain
  • Spread of infection

What is the survival rate and prognosis for stomach ulcers?

Most studies of prognosis, survival, and life expectancy involve people with peptic ulcer disease, which includes ulcers in either the stomach or duodenum, the first part of the small intestine, or in both these areas of the digestive tract. Duodenal ulcers are more common than stomach ulcers.

The prognosis for recovery is good for most people when the ulcer is uncomplicated and due to an identifiable cause, such as the bacterium Helicobacter pylori or from regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), and treatment is successful—antibiotics or discontinued NSAID use, respectively.

The prognosis is not as good when there are complications, such as bleeding. Effective ulcer treatments have decreased the number of people who develop complications, but the dangers of peptic ulcer bleeding remain the same. In a study following more than 8,000 adults hospitalized with peptic ulcer disease (in Finland), 3.7% died within 30 days; the main cause of death was related to peptic ulcer disease. At 1-year follow-up, peptic ulcer disease was the cause of death in less than 15% of cases; causes of death were related to heart disease, cancer, and other gastrointestinal diseases. Diagnosing and treating coexisting diseases, along with the ulcer, may improve long-term survival.

The survival rate of patients with a perforated or bleeding ulcer was lower than for hospitalized patients with uncomplicated ulcers. People hospitalized with a gastric ulcer fared worse than those with duodenal ulcers. Women had a worse prognosis than men in the study.

Curing an active peptic ulcer increases life expectancy. The curative effect is greater in younger people than older people. It also has more of an impact with complicated ulcers, such as bleeding ulcers.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 16
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